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PubMed1990

Simultaneous determination of hydroxylamine and cyanide in formulations containing pralidoxime salts by flow injection.

A flow injection method is described for the simultaneous determination of cyanide and hydroxylamine which are known decomposition products of formulations containing pralidoxime salts used in the treatment of anticholinesterase poisoning. By using the diffusion of HCN from the carrier stream followed by amperometric detection, high selectivity and sensitivity and a wide dynamic range can be achieved. Hydroxylamine is determined by its oxidation with iodine to nitrite which can then be determined colorimetrically. The gas diffusion unit effectively acts as a stream splitter for the two analytes allowing their simultaneous determination from a single sample injection. The performance of the system and its applicability to thermally stressed pralidoxime solutions are described.

Autoanalysis↗
PubMed2002

Potential use of autoinjector-packaged antidotes for treatment of pediatric nerve agent toxicity.

STUDY OBJECTIVE: We sought to determine the feasibility of discharging Mark 1 atropine and pralidoxime autoinjectors into small, sterile vials to facilitate the potential intramuscular injection of these antidotes, particularly pralidoxime, on a milligram per kilogram basis to small children. METHODS: Autoinjectors were swabbed with isopropyl alcohol and then discharged into emptied, sterile, plastic 10-mL vials. This was repeated with the investigator garbed in standard personal protective gloves and full face mask and hood. The autoinjector injection surfaces were cultured. RESULTS: The autoinjectors were easily discharged into the vials without need for practice or special dexterity, even when investigators were garbed in protective gear. A small core of rubber stopper might be injected into the vial, and thus, the vial contents need to be withdrawn through a filter needle before reinjection. The autoinjector injection surfaces were sterile after alcohol swabbing. CONCLUSION: Autoinjectors might be a readily available source of concentrated pralidoxime for potential intramuscular use in small children.

Antidotes↗
PubMed1998

Clinical and toxicological data in fenthion and omethoate acute poisoning.

This study paper reports on two cases of poisoning with the organophosphorus insecticides, fenthion and omethoate. The two victims were admitted in the Intensive Care Unit (ICU) a few hours after ingestion of the two insecticides. They received appropriate treatment for organophosphorous poisoning (gastric lavage, activated charcoal, atropine and pralidoxime) and supportive care. Both patients survived. Organophosphate blood levels were determined on admission (fenthion 2.9 micrograms/ml, omethoate 1.6 micrograms/ml) and during the hospitalisation and proved to be considerably high. Slow elimination rate of the poison already distributed in the body was indicated for both pesticides. The patient with omethoate poisoning remained clinically well (Glasgow Coma Scale: 15) and was discharged three days later. The patient with fenthion poisoning, who had also ingested 30 mg of bromazepam and 720 mg of oxetoron, developed cholinergic crisis six hours after admission and was intubated for 24 days, with concomitant complications.

Adult↗
PubMedDate not supplied

Pralidoxime safety and toxicity in children.

BACKGROUND: Currently, the safety of pralidoxime administration via adult autoinjectors for pediatric patients has not been established. Up until 2000, the published literature did not recommend its usage for children less than 12 kg or under the age of 10 years old. Since 2000, limited published articles have emerged validating adult autoinjector usage for the pediatric victim, in extreme circumstances. OBJECTIVE: We sought to determine whether adverse drug reactions (ADR) from pralidoxime administration to children occur. METHOD: Recurrent PubMed Medline literature search of all years were performed from 2001 to 2004 inclusive. The main search criteria were articles pertaining to U.S. children 16 years or younger who received pralidoxime. In addition, a review of 3 years (1999-2001) of detailed retrospective TESS exposure annual poison center data was obtained from the AAPCC. RESULTS: Eighty-one children met inclusion criteria and received pralidoxime for suspected organophosphate poisoning. Two children (2.5%) expired. Three children (3.7%) were identified as having a potential adverse drug reaction; all were mild. CONCLUSION: The author's recognize this study possesses limitations that require its findings be interpreted with caution. Our data suggest that adverse drug reactions to pralidoxime treatment in children are rare. However, further investigation is needed to more firmly establish the safety of this antidote in children and for its use in the prehospital environment.

Adolescent↗
PubMed2005

In vitro reactivation of sarin-inhibited brain acetylcholinesterase from different species by various oximes.

In vitro as well as in vivo evaluation of the reactivating efficacy of various oximes against nerve agent-inhibited acetylcholinesterase has been usually done with the help of animal experiments. Nevertheless, previously published data indicate that the reactivation potency of oximes may be different in human and animal species, which may hamper the extrapolation of animal data to human data. Therefore, to better evaluate the efficacy of various oximes (pralidoxime, obidoxime, HI-6, K033) to reactivate brain acetylcholinesterase inhibited by sarin by in vitro methods, human, rat and pig brain acetylcholinesterase were used to calculate kinetic parameters for the reactivation. Our results show differences among the species, depending on the type of oxime, and indicate that data from animal experiments needs to be carefully evaluated before extrapolation to humans.

Acetylcholinesterase↗